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=rUK cel-ric,t lSE: ----- ---- - -------- ------------ � -- - APPLICATION FOR SANITATION PERMIT Permit No. .•....__.. - -------------------------------------- ----------------- (Complete in Duplicate) l ----------- -------------- ----- - - -- Date Issued - - - This Permit Expires i Year From Date issued f Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein de crib d. This application is made in compliance with County Ordinance No. 49. f . o p'its ,�r�c asp�_ 7 aI7- 3 �{a—asJOB ADDRESS ANN LO ATIO ----- , Owner's Name Q --- - -•---•------------- a` ] hone Address--------- ------------ -_. - �sJ . i': ---'^\ - -•--- - ---..._---••-'-•----<...------------•------•-•.............- Contractor's Name--- -. t�-l�-------------•=�'-==r----- :••-----•-- -------------- - r_ - - ----------- ------------------------ Phone. Installation will serve: Residence ❑ Apartment Hou a❑,•Commercial ❑ Trailer Court ❑ Motel ❑ Other AA4d'� ( Number of living units: -_i"""__ Number of bedrooms..___._=--'Number of baths �� _ Lot size 4 Water Supply: Public system ❑ Commun'i s stem �" " - ty y .w❑. ,P iivate 7r Depth after Table ._-.____ ft, Character of soil to a depth of 3 fee+:S e d ❑� Gravel ❑ Sandy Loam Clay Loam 0w.Clay.-Elf Adobe❑ Hardpan ❑ Previous Application Made: Ilf yes date.--,\X --_"-_-----I No ❑ New Construction: Yes ❑ No.❑,_'FHA/VA. YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ E] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest well------_----------Distance from foundation__- _______. _"_ .MaterialNo. of compartments e _ -- ------------------- ---- --------------------- -------Liquid q depth------------ - CapacitY -------------- Dispos 'Reld: Distance from nearest well-.S-'P- -Distance from foundation-----1_f�_ ........Distance to nearest lot line___----"___ Number of lines___________ ___ Length of each line------/,_�,d- ____--._-Width of trench--_-_2______ Type of filter maferia��1- _ E ---- ----!_---Depth of filter material-------1.�'-""------Total length-:------��--C']-�"_____________"--_-- Seepage Pit: Distance to nearest well_____,___ __________Distance from foundation___..---------------Distance to nearest lot line_________________ ❑ plumber of pits----------------------Lining material---------- ----------- Size: Diameter._._.------------------Depth----------------------------- a f Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material _______________________"-_ ❑ Size: Diameter------------------------ -----------Depth------------------ ---------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------------------------------------------_Distance from nearest building --- -------- --------- 06. ❑ Distance to 'nearest lot line___-_________._.______ : Remodeling and/or repairing (describe):_ ____ -- �^ --- S.F -------------- ----•--------------------------•--------------------•-•---------------------------------------------------------•--------------------------------------- = I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County q ordinances, State s, and rules and regulations of the San Joaquin Local Health District. v (Signed)------- ---------------------- ---------------------------------- BY:------- - ---- �an r tree . d/o .Con tor) r.-..---- -- ------------------ --------------------------------------------(Title) .r (Plot plan, showing size of lot, location of system in rela+ion o wells, buildings,.etc., can be placed an reverse side---- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ � ----------- '"'`�-�..�- ---- ----- ----------- ------------ - DATE------ -------------------------- BUILDING --•- - -- - REVIEWED BY-----------------------•---------------------------------- - - --------- --------- --------- DATE--------------------------------------- UILDING PERMIT ISSUED----------------------------------------------------- ------------------ -------------- DATE ------------------ a Alterations and/or recommendations:______________________ _ 7■y - -------------------------------------- -------- ------------- ."________________________ _______________----------------------------------- ------------------------------------------------------ ------------ ______ _ FINAL INSPECTION BY: ', 1 Date------rlz_'+ SAN JOAQUINvLOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ?24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI:kD B•59 31A 3•'63 F.p•CO.